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Australia needs a more systematic and nationally coordinated approach to manage the escalating health burden arising from incarcerated older people

Based on figures from the Australian Bureau of Statistics,1 the number of prisoners aged 65 years and over has increased by 348% (805 people) over the past 16 years (Box 1). Troublingly, rates for older women, many of whom are Indigenous, have increased markedly (from 3 to 26 female prisoners; a 767% increase).1,2 While the younger prisoner population has stabilised, the older cohort has risen rapidly, with 5212 men and women aged 50 years and older currently in full-time custody in Australia (Box 2). Changes to laws in the 1990s, such as mandatory sentencing and standard non-parole periods, as well as better forensic techniques resulting in successful cold case prosecutions, have led to increased numbers of older offenders (aged 50 years and older), who now constitute over 13% of the total Australian prisoner population.3,4 Notably, the Royal Commission into Institutional Responses to Child Sexual Abuse resulted in many convictions of older men relating to historical sexual abuse offences.5 Additionally, population ageing has led to increased rates of people with dementia, for which criminal behaviour can be a presentation.6 Indeed, criminal cases have emerged where the offender’s cognitive status has been examined as part of the judicial process to determine whether cognitive impairment played a role in their actions. Older offenders are therefore a mixed group. Some are older first time offenders who are diverted because of cognitive impairment, some are career recidivists. Others are prosecuted for historical offences and, although they may have been of sound mind at the time of the crime, are now frail. These groups require specific medico-legal care arrangements that the justice system is still developing.

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We are grateful for the support of the Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR; CE170100005) and would like to thank Rafal Chomik (Senior Research Fellow, CEPAR) and John Piggott (Director, CEPAR) for their guidance on the projected health costs of the Australian prisoner and general population. Tony Butler is supported by a National Health and Medical Research Council Research Fellowship (1124299).

Competing interests:

No relevant disclosures.

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